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PubMed1977

Target fertility, contraception, and aggregate rates: toward a formal synthesis.

This paper develops a stock adjustment model relating total expected births to conventional aggregate fertility rated for married women over 25. Each year, cohorts bear about 20 percent of their additional expected births. Aggregate U.S. rates have been consistent with expectations as expressed in surveys between 1955 and 1975; indeed, total expected births may be inferred from aggregate fertility behavior. A peculiar empirical finding is that the additional expected fertility of nonterminators has not changed since 1955, despite the dramatic decline in total expected and actual fertility. The model leads to a dynamic expression for the duration pattern of current and cumulative fertility and for the proportion of couples who have terminated childbearing. The model is also used to analyze the effects of changing contraceptive failure rates on fertility patterns. For example, a decline in "timing" failure rates increases duration-specific fertility five years later.

Adult↗
PubMed1975

Formulation of goals for life expectancy at birth in Costa Rica (report of one experience).

Costa Rican authorities have finished a national adaptation of the goals of the Hemisphere's Ten-Year Health Plan for the Americas and have formulated a National Health Plan for 1974-1980. This work was coordinated by the Health Sector Planning Unit and was assisted by various multidisciplinary and multi-institutional working groups. The methodology set forth in this article was developed by a group responsible for formulating goals with regard to life expectancy--the last of five health-related subjects analyzed, and one regarded as dependent on the rest. In brief, this methodology was as follows: Birth rates, death rates, and life expectancy at birth in the other countries of the Region and in a developed country (Sweden) were compared with those prevailing now and in the past in Costa Rica. This served as a basis for projecting Costa Rica's future prospects if no changes were made, or if certain changes were made through implementation of new programs. This was followed by analysis of leading caused of death in the country--by age group and vulnerability of those dying, and by probably reductions in mortality that would result from achieving the goals established for other programs. On this basis, various alternative reductions in mortality for each age groups were considered. Using these alternative, abridged life tables were devised, and these in turn were used to draw up a table showing the life expectancy at birth that would result from realization of each alternative. This made it possible to derive life expectancy goals that were consistent with the goals for reducing mortality in each age group that were formulated during the sectoral planning process. It is hoped that this general procedure, illustrated here with data from the Costa Rican case, may prove useful to others engaged in health planning work.

Adolescent↗
PubMed1997

Reliability of statistics on Down's syndrome notifications.

OBJECTIVES: To evaluate the completeness of notifications of Down's syndrome live births and terminations to the Office for National Statistics (ONS) using data from the National Down Syndrome Cytogenetic Register (NDSCR). To examine the agreement of observed birth prevalence of Down's syndrome with the expected birth prevalence derived from published maternal age specific rates. METHODS: The number of live births (adjusted to allow for the estimated underascertainment) and the number of terminations due to fetal Down's syndrome from NDSCR were compared with those figures reported to the ONS. Subsequently, using the NDSCR figures, the live birth prevalence of Down's syndrome that would have occurred in the absence of antenatal diagnosis and selective termination was calculated in England and Wales in the years 1990-1993. These figures were compared with those derived by applying published age specific prevalences to the maternal age distribution in England and Wales. RESULTS: It is estimated that only 48% and 46% respectively of Down's syndrome live births and terminations of pregnancy were notified to ONS between 1990 and 1993. The annual expected birth prevalences of Down's syndrome obtained by applying maternal age specific prevalences to the maternal age distribution were in close agreement with observed rates from NDSCR. CONCLUSIONS: There is considerable underreporting of Down's syndrome births and terminations to ONS. The NDSCR data are more complete and therefore the effects of screening should be monitored using data from this source, or using estimates derived from the age specific rates of Down's syndrome.

Abortion, Induced↗
PubMed2000

Preeclampsia and fetal growth.

OBJECTIVE: To determine if the influence of preeclampsia on birth size varies with clinical manifestations of the disease, and to evaluate whether maternal factors, such as smoking, modify the effect of preeclampsia on fetal growth. METHODS: Among 12,804 deliveries in a population of approximately 239,000 over a 3-year period, 307 live singleton infants were born after preeclamptic pregnancies. We compared those with a sample of 619 control infants. Preeclampsia was defined as increased diastolic blood pressure (BP) (increase of at least 25 mmHg to at least 90 mmHg) and proteinuria after 20 weeks' gestation. Clinical manifestations were classified according to BP and proteinuria into subgroups of mild, moderate, or severe (including cases with eclampsia and hemolysis, elevated liver enzymes, low platelets [HELLP] syndrome) preeclampsia, and according to gestational age at onset, as early or late preeclampsia. Birth size was expressed as the ratio between observed and expected birth weights, and infants smaller than two standard deviations from expected birth weights were classified as small for gestational age (SGA). RESULTS: Preeclampsia was associated with a 5% (95% confidence interval [CI] 3%, 6%) reduction in birth weight. In severe preeclampsia, the reduction was 12% (9%, 15%), and in early-onset disease, birth weight was 23% (18%, 29%) lower than expected. The risk of SGA was four times higher (relative risk [RR] = 4.2; 95% CI 2.2, 8.0) in infants born after preeclampsia than in control pregnancies. Among nulliparas, preeclampsia was associated with a nearly threefold higher risk of SGA (RR = 2.8; 1.2, 5.9), and among paras, the risk of SGA was particularly high after recurrent preeclampsia (RR = 12.3; 3.9, 39.2). In relation to preeclampsia and maternal smoking, the results indicated that each factor might contribute to reduced growth in an additive manner. CONCLUSION: Severe and early-onset preeclampsia were associated with significant fetal growth restriction. The risk of having an SGA infant was dramatically higher in women with recurrent preeclampsia. Birth weight reduction related to maternal smoking appeared to be added to that caused by preeclampsia, suggesting that there is no synergy between smoking and preeclampsia on growth restriction.

Adult↗
PubMed1991

Late expectations: childbearing patterns of American women for the 1990's.

"This paper will examine the changes in the timing of entry into motherhood among post World War II birth cohorts of women and the childbearing patterns of women after age 30 [in the United States]. The principal data source used in this paper will be the Census Bureau's fertility and birth expectations survey from the Current Population Survey (CPS)....A brief summary of the origins and evolving problems associated with using birth expectations data as a method to predict future fertility swings will first be examined. Next, the usefulness of expectations data as a predictor of the future will be discussed in the context of historical patterns of childbearing....Finally, this paper will examine which socioeconomic groups of women are most likely to be characterized by delays in childbearing and their current prospects for having their first birth at later ages."

Age Factors↗
PubMed1989

Cesarean sections for maternal indications in Kasongo (Zaire).

Cesarean section rates in a rural area in Eastern Zaire are described. Indications are stringent and section is essentially performed on maternal indications. In the urban area cesarean section was performed for 1.1% of the expected births over a 9-year period, but only for 0.3% of expected births in the rural area, indicating a major problem in access to the district hospital. Section rates are compared with those reported for other settings.

Cesarean Section↗
PubMed1999

Use of hospital data for Safe Motherhood programmes in south Kalimantan, Indonesia.

The evaluation of Safe Motherhood programmes has been hampered by difficulties in measuring the preferred outcomes of maternal mortality and morbidity. The need for adequate indicators has led researchers and programme managers alike to resort to indicators of utilization and quality of health services. In this study we assess the magnitude of four indicators of use of essential obstetric care (EOC) and one indicator of quality of care in health facilities in three districts in South Kalimantan, Indonesia. The general picture which emerges for South Kalimantan is that the use of obstetric services is low. Even in the more urban district of Banjar where facility-based coverage is highest, fewer than 14% of all deliveries take place in an EOC facility, 2% of expected births are admitted to such a facility with a major obstetric intervention (MOI), and 1% of expected births have an MOI for an absolute maternal indication. The use of facility-based EOC is consistently lower in Barito Kuala compared to the other districts, and the differences persist regardless of the indicators used. In this setting with low utilization rates, general rates of utilization of EOC facilities seem to be as satisfactory an indicator of relative access to EOC as more elaborate indicators specifying the reasons for admission. The inequalities in access to care revealed by the various indicators of use of EOC services may prove to be a more powerful stimulus for change than the widely reported and highly inaccurate accounts of the high levels of maternal mortality.

Delivery, Obstetric↗
PubMedDate not supplied

[Analysis of data routinely collected in the maternity ward of Rutshuru in the Democratic Republic of the Congo between 1980 and 1998. I. Maternal mortality and obstetrical interventions].

UNLABELLED: This report is the first of 2 papers that analyse data routinely collected in the maternity ward of Rutshuru (democratic Republic of Congo). The present work describes the evolution of caesarean section, maternal deaths and the associated risk factors. MATERIAL AND METHODOLOGY: Between 1980 and 1998, data on 13,042 deliveries were collected. Characteristics, mortality, morbidity of mothers and new-borns and obstetrical interventions were recorded. The statistical analyses applied included khi2, t-test, simple linear and multiple logistic regression. RESULTS: Fifteen percent had a caesarean section and 1.9% of women died. When referred to the expected births during the period, these numbers led to a ratio of 150 maternal deaths for 100,000 expected births and a ratio of caesarean section of 1.2%. At admission, 35% of the women presented at least one of the four risk factors used for reference. The proportion of women with at least one of the 4 risk factors went up from 26.1% to 39.5%. The proportion of caesarean sections went up from 1.9% to 34.1%. The proportion of maternal deaths remained constant except in 1988, 1994, 1995 and 1997. Three of the four reference factors, the Baudeloque diameter, parity and height were associated with caesarean section. Age only was associated with maternal death. Education and marital status were both associated with caesarean section and maternal death. CONCLUSION: This analysis shows high levels of maternal mortality and caesarean section. The authors recommend to analyse on a larger scale the value of the reference factors used in antenatal services and to standardise indications for the different obstetrical interventions.

Adolescent↗
PubMed1993

Effects of selection strategies using heifer pelvic area and sire birth weight expected progeny difference on dystocia in first-calf heifers.

A stochastic computer simulation model was developed to evaluate the effects of selection strategies based on heifer pelvic area and sire birth weight EPD on dystocia in first-calf heifers. Parameters and relationships used were taken from the literature. Unrelated sets of yearling heifers were simulated. Replacement heifer selection was based on breeding the top 40, 60, 80 or 100% (i.e., no selection) of available heifers as determined by yearling pelvic area (YRLGPA). Selected heifers were bred to bulls that were selected based on EPD for birth weight (SEPD). Levels of SEPD were -2.7, -1.8, -.9, 0, .9, and 1.8 kg. Simulated responses included precalving pelvic area, calf birth weight, calving difficulty score (1, 2, 3, 4), and incidence of dystocia (0, 1). Both measures of dystocia were predicted from the ratio of precalving pelvic area to calf birth weight. Simulated data were analyzed using least squares procedures. The effects of SEPD were significant (P < .05) for birth weight, calving difficulty score, and the frequency of dystocia. Differences among levels of heifer selection for YRLGPA were significant for YRLGPA, precalving pelvic area, birth weight, and calving difficulty score but not for the frequency of dystocia. Based on partial regressions calculated from weighted replication means, a 1-kg decrease in SEPD will decrease average calving difficulty score by .12 units and decrease the frequency of dystocia by 4%, whereas each 10% increase in selection pressure on YRLGPA will reduce the average calving difficulty score by only .02 units and have no detectable effect on the frequency of dystocia.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed2004

[The role of corticosteroids in the lungs' maturation in expected premature birth].

Cortikosteroids, a hormons of adrenal glands have a influence to almost all organic sistems because of their antiinflamatory and immunosupressive effects. They are used in perinatology to accelerate lungs maturation in expected premature labour. The most frequent used corticosteroids are bethamethason and dexamethason, with useful effects: acceleration of growth of fetal lungs by ripening pneumocites type II and supression of creating secundary septs; by protection of brain from intraventricular haemorrhage and periventricular leucomalation; decreasing rate of rethinopathy and enterocolitis and ductus artheriosus persistens. By this way the mortality rate ofpreterm newborns is decreased in 60% of cases. Expected harmful effects of antenatal using of corticosteroids are: high blood pressure of newborns in first 24 hours after delivery, the possible oedema of lungs, in simultaneous using of corticosteroids and bethamimetic treatment. It is not recommended to repeat treatment by corticosteroids in same pregnancy because of hormonal influence to fetal growth and neurological development, till clear benefit is not proved.

Female↗
PubMed1993

Gonadal sex differentiation in embryos and neonates of the marsupial, Monodelphis domestica: arrest of testis development in postterm embryos.

Growth and histological differentiation were studied in 8 litters of embryos and 4 litters of neonate grey short-tailed opossums, Monodelphis domestica. The embryonic litters included 2 that had passed their expected birth date, and whose weights exceeded the usual birthweights; we refer to these litters as 'postmature'. There was an abrupt increase in the growth rate of XY gonads after birth, but this was not seen in XX gonads. Although there was evidence of testicular differentiation in XY gonads on the day before the expected birth, testicular differentiation was found to be blocked in postmature litters. The growth of XX gonads in postmature embryos was not affected. In view of evidence that exogenous oestrogens feminise the gonads of genetic males in some species of marsupials including Monodelphis domestica, the question arises whether oestrogen is responsible for the failure of testes to continue their development in utero. We suggest that the ability of functional testes to develop in the presence of oestrogen may be a fundamental requirement distinguishing eutherian mammals from other vertebrates, including marsupials.

Animals↗